Jurga Juliane, Tornvall Per, van der Linden Jan, Sarkar Nondita
Department of Cardiology, Karolinska University Hospital/Solna, N3:05, SE 171 76 Stockholm, Sweden. Email:
J Invasive Cardiol. 2014 Jan;26(1):1-6.
Microemboli are frequently detected entering the middle cerebral arteries during coronary angiography (CA). Recent studies have reported that cerebral microemboli, especially particulate cerebral microemboli, may cause silent ischemic cerebral lesions.
To investigate whether the occurrence of particulate cerebral microemboli during diagnostic CA is influenced by which guidewire technique is used.
Patients with stable angina pectoris or non-ST elevation acute coronary syndrome, referred for CA, were randomized to initial advancement of catheters with a leading guidewire over the aortic arch or to initial guidewire withdrawal in the descending aorta with advancement of catheters alone. After completed CA (part 1), new catheters and guidewires were advanced with guidewire technique contrary to the one first used (part 2). Patients were continuously monitored with transcranial Doppler (TCD), and cerebral microemboli were automatically counted and differentiated.
Statistical analysis was performed on 41 patients. The results in part 1 were confirmed in part 2. The median number (interquartile range) of particulate cerebral microemboli was significantly higher when catheters were advanced with, compared to without, a guidewire over the aortic arch; overall, 6 (IQR, 1-9) vs 1 (IQR, 0-3); P=.01.
Advancement of catheters with a leading guidewire over the aortic arch with subsequent flushing in the ascending aorta consistently generated more particulate cerebral microemboli, implying that the choice of guidewire technique has an impact on the risk for cerebral lesions during CA.
在冠状动脉造影（CA）期间，经常检测到微栓子进入大脑中动脉。最近的研究报告称，脑微栓子，尤其是颗粒性脑微栓子，可能会导致无症状性缺血性脑损伤。
研究在诊断性CA期间，颗粒性脑微栓子的发生是否受所使用的导丝技术影响。
因CA就诊的稳定型心绞痛或非ST段抬高急性冠状动脉综合征患者，被随机分为两组，一组是通过主动脉弓在导丝引导下先推进导管，另一组是仅在降主动脉中先回撤导丝然后推进导管。在完成CA（第1部分）后，使用与首次使用相反的导丝技术推进新的导管和导丝（第2部分）。使用经颅多普勒（TCD）对患者进行连续监测，并自动计数和区分脑微栓子。
对41例患者进行了统计分析。第1部分的结果在第2部分得到了证实。与没有导丝引导在主动脉弓推进导管相比，有导丝引导推进导管时颗粒性脑微栓子的中位数（四分位间距）显著更高；总体而言，分别为6（四分位间距，1 - 9）和1（四分位间距，0 - 3）；P = 0.01。
通过主动脉弓在导丝引导下推进导管并随后在升主动脉中冲洗，始终会产生更多的颗粒性脑微栓子，这意味着导丝技术的选择对CA期间脑损伤的风险有影响。
